Candidate

Instructions

The patient in the next room is Anika, who is 40 years old. She is complaining of lethargy, cold intolerance and weight gain in the past 12 months. You have been given this patients past medical history. You are not expected to ask any further history from this patient. You have eight (8) minutes to perform a focused examination with respect to the presenting complaint. Do not make any inferences based on the appearance of the role player. You are expected to explain to the examiner the specific findings that you are looking for during your examination. TASKS Focussed examination including reasoning to each part of examination to the examiner 8 minutes

Year 2 OSCE Practice 2011 Set 1, Examination Station

Past Medical History: Pernicious anaemia 10 years ago Vitiligo Obstetric History G2P2 2x SVD Past Surgical History: Appendicectomy aged 8 yrs old Immunizations : Up to date

Meds B12 injection 3 monthly Mirena IUD Allergies /ADRs Nil known

Family History: Both parents alive and well Maternal side- T2DM Paternal side- ischaemic heart disease and hypertension

Lifestyle Smoking non smoker Alcohol 3-4 units wine at weekends only Diet normal Exercise minimal Hobbies scrapbooking Pets none

Demographics Occupation Stay at home mum Living arrangements lives at home with husband and 2 teenage kids Family Parents, 2 children, older sister.

Year 2 OSCE Practice 2011 Set 1, Examination Station

Instructions to Examiners

The task for the candidate The candidate has eight (8) minutes to perform a thyroid/endocrine examination to try to determine the reason for this patients lethargy, cold intolerance and weight gain. Conduct of the Station Ensure that the candidate understands the task that he/she has to do. The candidate is expected to interact appropriately with the patient- including introducing themselves, and obtaining consent for the examination.

The candidate has been told to explain to the examiner the specific findings they are looking for during their examination. They are not to make any inferences based on the appearance of the role player. Please prompt the candidates if they are performing the examination in silence- or talking to the patient instead using the phrases below. Please indicate the signs you are specifically looking for Please talk me through your examination, as you are performing it. There will not a warning bell mid station, so please use the timer provided. During the course of the interview the candidate may refer to any notes they have made during the perusal time.
Year 2 OSCE Practice 2011 Set 1, Examination Station

MARKING
Examiners are asked to grade students performance on a scale of 0 - 4 in the areas on the mark sheet in capitals. The standards for awarding these grades are; 0 = Unequivocal fail: Student was unable to demonstrate history or examination skills without significant prompting, OR displayed unethical or unprofessional behaviour. Student lacked a comprehensive approach, and/or needed considerable prompting to complete the task.

1 = Marginal fail: 2 = Borderline pass: 3 = Clear pass: 4 = High pass:

Student performed a systematic examination or history but did not complete some components in a number of areas of the marking guide. Student had a systematic approach, required little or no prompting, was confident and completed most components of the marking guide.

Student had a high level of proficiency, well above what would be expected of a student in Year 2.

Examiners are required to make an overall judgement about the students performance in each area on the marking sheet. The specific items listed are there to remind examiners about issues which might be considered. It is not intended that these items should rigidly translate into a score. It would be helpful, particularly when feedback is being given to poorly performing students, if there is some notation in the comments column. Also examiners may find it helpful, when considering what grade to award, to have indicated in the comments column when items were omitted or when prompting was required. Global Score. This mark does not form part of the students overall mark. The score should reflect the students empathy and overall performance, and is from the examiners perspective only.
Year 2 OSCE Practice 2011 Set 1, Examination Station

Feature Introduction/General Who/role Permission Wash hands Appropriate Pt interaction Positioning (patient sitting)

Comment

Score (please circle) 0 1 2 3 4

General Inspection: Hyperthyroid Body habitus, wt loss Distress/anxiety

0 1 2 3 4

Hypothyroid Psychomotor retardation/sluggishness (myxoedema madness). Vitiligo 0 1 2 3 4

Hands

Hyperthyroid Tremor Onycholysis Clubbing Palmar erythema Warmth/sweating/clammy

Hypothyroid
Year 2 OSCE Practice 2011 Set 1, Examination Station

Cyanosis Swelling Cool/dry

Arms Hyperthyroid Radial pulse tachycardia/AF/collapsing pulse Proximal myopathy. Hyperreflexia (BJ, TJ, SJ)

0 1 2 3 4

Hypothyroid Radial pulse braycardia Proximal myopathy (rare) Reflexes (BJ, TJ, SJ) normal contraction with delayed relaxation hung-up reflex. 0 1 2 3 4

Face Hyperthyroid Exopthalmos Lid retraction Lid lag

Hypothyroid Skin thickening (myoedema) Periorbital oedema Yellow pigmentation (hypercarotenaemia) Alopecia Loss of outer 1/3 of eyebrows Xanthelasma Cool/dry skin Tongue swelling Voice change (coarse, croaking, slow speech)

Year 2 OSCE Practice 2011 Set 1, Examination Station

Both Neck Inspect: front and sides swallowing (provide glass of water) Goitre Nodule Thyroidectomy scar Venous congestion (upper chest and ext jugular) Erythema (rare: suppurative thyroiditis) Pembertons sign (retrosternal goitre) 0 1 2 3 4

Palpate: from behind sitting Pt Neck slightly flexed Systematically both lobes + isthmus Cervical lymph nodes Tracheal deviation. Carotid pulse

Repeat with Pt swallowing. Auscultate: each lobe for bruits Chest Hyperthyroid Inspect: Gynaecomastia 0 1 2 3 4

Auscultate: Systolic murmurs (due to inc CO)

Year 2 OSCE Practice 2011 Set 1, Examination Station

Chest Hyperthyroid Inspect: Gynaecomastia

0 1 2 3 4

Auscultate: Hypothyroid Auscultate: Legs Hyperthyroid Inspect: Test:

Systolic murmurs (due to inc CO) Basal crepitations CCF

Pericardial effusion Pleural effusion. 0 1 2 3 4

Pretibial myxoedema

Proximal myopathy Hyperreflexia (AJ, KJ)

Hypothyroid Inspect: Pass Mark = 15/20 Pass/ Fail (Circle as appropriate) Non-pitting oedema Comments (essential if the candidate has failed the station) Test: Reflexes (AJ, KJ) hung-up reflex. Peripheral neuropathy. Global Impression- from examiners only- score 0-4

Year 2 OSCE Practice 2011 Set 1, Examination Station

 Instructions to Standardised Patient

You are playing Anika- a 40 year old lady, who has been complaining of lethargy, cold intolerance and weight gain. The students are NOT expected to take any further history from you regarding you presenting complaint. However they are expected to interact appropriately with you as a patient. The students should commence with introducing themselves and obtaining verbal consent to examine you. They should also ensure you are comfortable on the examination couch. If they fail to introduce themselves- please ask Who are you exactly? If they fail to ask for your consent- please ask What exactly are you going to be doing? The students should start with a peripheral examination of your hands arms, face, eyes and neck, before moving on to your heart and lungs and finally the lower limbs. You will be required to exposure you chest to allow the students to examine your cardiovascular/ respiratory system (heart and lungs). This examination will take eight (8) minutes. During this time the students are expected to explain to the EXAMINER the specific findings that they are looking for. They will be talking to the examiner, as requested and you are not expected to respond to their comments.

Year 2 OSCE Practice 2011 Set 1, Examination Station